1
|
Antwi A, Schill AW, Redfern R, Ritchey ER. Effect of low-level light therapy in individuals with dry eye disease. Ophthalmic Physiol Opt 2024. [PMID: 39096028 DOI: 10.1111/opo.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Low-level light therapy (LLLT) or photobiomodulation, the application of red light to the eye, is used for the treatment of dry eye. Limited studies have investigated the efficacy of LLLT as a stand-alone treatment. The investigation aimed to evaluate the effect of LLLT on signs and symptoms of dry eye. METHODS Participants with mild to moderate dry eye were recruited for this three-visit study. Visits were 7 (±3) days apart and all participants received 633 nm LLLT (eye-light®) for 15 min at each visit. Clinical measures including first and average non-invasive keratograph tear break-up time (NIKBUT), tear meniscus height (TMH), meibomian gland (MG) loss for upper and lower eyelids, ocular surface disease index (OSDI) score, tear film lipid layer thickness, meibum quality score, Schirmer's test, corneal fluorescein staining and eyelid temperature for external upper (EUL) and external lower (ELL) eyelids were measured from the right eye of participants before and after treatment. RESULTS Thirty participants (mean [SD] age: 31.1 [9.5] years) completed the study. Treatment with LLLT resulted in significant differences in first and average NIKBUT, TMH, tear film lipid layer thickness, OSDI score, Schirmer's test, meibum quality score and eyelid temperature over time (all p < 0.05). Compared to baseline, TMH, tear film lipid layer thickness and eyelid temperature significantly increased by 0.06 mm (95% CI: 0.01-0.11), 12.9 nm (95% CI: 1.18-24.55), and 7.0°C, respectively, for both EUL (95% CI: 6.17-7.84) and ELL (95% CI: 6.17-7.73). The respective decrease in the OSDI score and Schirmer's test was 10.2 (95% CI: -15.15 to -5.26) and 4.4 mm (95% CI: -7.31 to -1.42; all p < 0.05). There was no significant difference in corneal fluorescein staining and MG loss after LLLT. CONCLUSION Low-level light therapy treatment significantly improved signs and symptoms of dry eye in the early phases of treatment, suggesting its efficacy for dry eye management.
Collapse
Affiliation(s)
| | | | - Rachel Redfern
- University of Houston College of Optometry, Houston, Texas, USA
| | - Eric R Ritchey
- University of Houston College of Optometry, Houston, Texas, USA
| |
Collapse
|
2
|
Giannaccare G, Rossi C, Borselli M, Carnovale Scalzo G, Scalia G, Pietropaolo R, Fratto B, Pellegrini M, Yu AC, Scorcia V. Outcomes of low-level light therapy before and after cataract surgery for the prophylaxis of postoperative dry eye: a prospective randomised double-masked controlled clinical trial. Br J Ophthalmol 2024; 108:1172-1176. [PMID: 37890879 DOI: 10.1136/bjo-2023-323920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Despite increasing evidence shows that optimising ocular surface before cataract surgery is fundamental in patients with pre-existing dry eye disease (DED) to achieve the desired postoperative outcomes, the prophylactic treatment of healthy patients undergoing surgery aiming at preventing iatrogenic DED is worth investigating. METHODS This was a prospective, interventional, randomised, controlled, double-masked clinical trial. Patients were randomly assigned 1:1 to receive either low-level light therapy (LLLT) or sham treatment (LLLT with a power output <30%). Patients underwent two treatment sessions: 7±2 days before cataract surgery (T0) and 7±2 days after (T1). Outcome measures evaluated 30±4 days after surgery (T2) included Ocular Surface Disease Index (OSDI) questionnaire, non-invasive break-up time (NIBUT), tear meniscus height, meibomian gland loss (MGL) and redness score. RESULTS Out of 153 patients randomised to receive LLLT (n=73) or sham treatment (n=80), 131 (70 men, 61 women, mean age 73.53±7.29 years) completed regularly the study. Patients treated with LLLT had significantly lower OSDI scores compared with controls at T1 and T2 (respectively, 7.2±8.8 vs 14.8±13.0 and 9.0±9.0 vs 18.2±17.9; both p<0.001), higher NIBUT values at T2 (12.5±6.6 vs 9.0±7.8; p=0.007) and lower MGL Meiboscore values at T1 (1.59±0.70 vs 1.26±0.69; p=0.008). Unlike controls, patients treated with LLLT had significantly lower OSDI scores and higher NIBUT values at T2 compared with T0 (respectively, 9.0±9.0 vs 21.2±16.1; p<0.001 and 12.5±6.6 vs 9.7±7.2; p=0.007). CONCLUSION Two sessions of LLLT performed before and after cataract surgery were effective in ameliorating tear film stability and ocular discomfort symptoms. TRIAL REGISTRATION NUMBER NCT05754437.
Collapse
Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Costanza Rossi
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Massimiliano Borselli
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Giovanni Scalia
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rocco Pietropaolo
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Benedetta Fratto
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Marco Pellegrini
- Department of Ophthalmology, Villa Igea Hospital, Forlì, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Angeli Christy Yu
- Department of Ophthalmology, Villa Igea Hospital, Forlì, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
3
|
Gupta AS, Massaro M, Bunya VY. Intense pulsed light treatment for the management of meibomian gland dysfunction. Curr Opin Ophthalmol 2024; 35:322-328. [PMID: 38813738 DOI: 10.1097/icu.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD. RECENT FINDINGS In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks. SUMMARY There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.
Collapse
Affiliation(s)
- Angela Satya Gupta
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
4
|
Wang H, Yin X, Li Y, Zhang Z, Zhao K, Hu F, Liu Q, Lu Q, Wang Y, Zhang L, Jia H, Han J, Guo J, Li M. Safety and efficacy of intense pulsed light in the treatment of severe chronic ocular graft-versus-host disease. Ocul Surf 2023; 30:276-285. [PMID: 37813151 DOI: 10.1016/j.jtos.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/27/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of intense pulsed light (IPL) in the treatment of severe chronic ocular graft-versus-host disease (coGVHD). METHODS A prospective cohort study. Seventeen patients with severe coGVHD were selected for inclusion in this study. All subjects were treated with IPL every fortnight together with conventional treatment, observation time points were pre-treatment (W0), 4 weeks post-treatment (W4), 8 weeks post-treatment (W8) and 12 weeks post-treatment (W12). Dry eye related examinations include Tear meniscus height (TMH), Non-invasive break-up time (NIBUT), Schirmer I test, Tear film lipid layer thickness (LLT), Ocular surface staining (OSS) and assessment of meibomian gland. Corneal epithelial cell morphology and inflammatory cell infiltration were analyzed by corneal confocal microscopy, while goblet cell density and squamous epithelial grade were assessed by conjunctival imprinted cytology. RESULTS Patients did not experience any adverse reactions during the follow-up period. All subjects showed significant improvement in clinical symptoms and most signs after IPL treatment. The corneal confocal microscopy showed that the number of dendritic cells infiltrates in the corneal stroma was significantly reduced after IPL treatment (p < 0.001). Conjunctival blot cytology suggested an increase in the number of conjunctival goblet cells from 5.12 ± 2.71 cells/mm2 before treatment to 22.00 ± 4.58 cells/mm2 after treatment, with a statistically significant difference (p < 0.001). An improvement in conjunctival epithelial cell morphology and a decrease in squamous epithelial grade was also observed. CONCLUSIONS IPL treatment can effectively increase tear film stability in patients with severe coGVHD without significant side effects.
Collapse
Affiliation(s)
- He Wang
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Xiaoyue Yin
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yue Li
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Zhaowei Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Kai Zhao
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Fen Hu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qian Liu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qiuchen Lu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yining Wang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Ling Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Hui Jia
- From the Institute of Environment and Ecology, Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, China
| | - Jiaxin Han
- College of Optometry, Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China
| | - Jianxin Guo
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Mingxin Li
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China.
| |
Collapse
|
5
|
Zeng H, Gong L. A Review of Applications and Intracellular Mechanisms of Intense Pulsed Light in Eyelid Inflammatory Diseases. Photobiomodul Photomed Laser Surg 2023; 41:104-119. [PMID: 36927050 DOI: 10.1089/photob.2022.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Objective: To evaluate relevant clinical outcomes and conclude possible mechanisms of intense pulsed light (IPL) in eyelid inflammation. Background: IPL devices were primarily applied in cutaneous vascular malformations and have been used in ocular diseases for about 20 years, mostly including meibomian gland dysfunction (MGD), blepharitis, and ocular rosacea. Recent findings: Seventy-two original clinical researches were included, 57 for MGD, 4 for blepharitis or blepharitis-related keratoconjunctivitis, and 11 for rosacea. Dry eye symptoms, (tear) break-up time (BUT), and meibomian structure and/or functions were improved in most patients, but production of reactive oxygen species is an important link in the photobiomodulation mediated by IPL, which can influence numerous signal pathways to achieve anti-inflammatory, anti-infective, and prodifferentiation effects. Conclusions: The evidence suggests that IPL is an effective therapeutic tool for most patients with MGD, but more clinical evidence is needed for other indications.
Collapse
Affiliation(s)
- Hongya Zeng
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Lan Gong
- Department of Ophthalmology and Vision Science, the Eye & ENT Hospital of Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China
| |
Collapse
|
6
|
Giannaccare G, Vaccaro S, Pellegrini M, Borselli M, Carnovale Scalzo G, Taloni A, Pietropaolo R, Odadi AS, Carnevali A. Serial Sessions of a Novel Low-Level Light Therapy Device for Home Treatment of Dry Eye Disease. Ophthalmol Ther 2023; 12:459-468. [PMID: 36484948 PMCID: PMC9834479 DOI: 10.1007/s40123-022-00619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This study aimed to evaluate the changes that a recently developed at-home device using low-level light therapy (LLLT) produced in signs and symptoms of patients with dry eye disease (DED) owing to meibomian gland dysfunction (MGD). METHODS In this prospective study, patients with DED owing to MGD not successfully responding to first-line therapy (tear substitutes and eye lid hygiene) were treated with four serial sessions (every other day) of mask based on LLLT technology and dedicated for home use (my-mask®, Espansione Marketing S.p.A., Bologna, Italy). Non-invasive ocular surface examination was carried out by means of Keratograph 5M (Oculus, Wetzlar, Germany) before and after four mask sessions for the evaluation of (i) tear meniscus height (TMH); (ii) first and average non-invasive Keratograph breakup time (NIKBUT); (iii) meibomian gland loss (MGL). Ocular Surface Disease Index (OSDI) questionnaire was used to assess ocular discomfort symptoms. RESULTS Overall, 17 patients (3 male, 14 female; mean age 61.47 ± 11.93 years) were enrolled and all of them regularly completed the entire cycle of four sessions without reporting any adverse event. The mean values of NIKBUT first and NIKBUT average increased significantly after treatment (from 5.29 ± 2.60 at T0 to 9.04 ± 3.49 s at T1 [P = 0.001] and from 9.40 ± 3.81 to 11.28 ± 2.81 s [P = 0.017]); in parallel, the mean value of TMH increased significantly from 0.27 ± 0.06 to 0.32 ± 0.09 mm (P = 0.029). Conversely, there were not statistically significant differences for MGL (P = 0.346). In addition, the mean value of OSDI score decreased after treatment (from 32.00 ± 7.96 at T0 to 20.71 ± 8.03 at T1; P < 0.001). CONCLUSIONS One week of serial sessions of a newly developed LLLT device for home use significantly improved tear film production and stability along with ocular discomfort symptoms in patients with DED owing to MGD. These findings open up a new scenario for patients with MGD who can enjoy the unique benefits of LLLT at home.
Collapse
Affiliation(s)
- Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy ,Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, Forlì, Italy ,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Giovanna Carnovale Scalzo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | - Rocco Pietropaolo
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| | | | - Adriano Carnevali
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy
| |
Collapse
|
7
|
Nguyen A, Kolluru A, Beglarian T. Dry eye disease: A review of anti-inflammatory therapies. Taiwan J Ophthalmol 2023; 13:3-12. [DOI: 10.4103/2211-5056.369606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 02/15/2023] Open
|
8
|
Ballesteros-Sánchez A, Gargallo-Martínez B, Sánchez-González MC, Sánchez-González JM. Intense Pulse Light Combined With Low-Level Light Therapy in Dry Eye Disease: A Systematic Review. Eye Contact Lens 2023; 49:8-13. [PMID: 36455215 DOI: 10.1097/icl.0000000000000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/11/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES To evaluate the improvement in symptoms and signs associated with intense pulse light (IPL) combined with low-level light therapy (LLLT) in the treatment of dry eye disease (DED). METHODS A systematic review of full-length original studies reporting the effects of IPL combined with LLLT for DED in two databases, PubMed and Scopus, was performed according to the PRISMA statement. The quality assessment tool for case series studies from the National Heart, Lung, and Blood Institute was used to analyze the quality of the studies selected. RESULTS The search provided a total of 393 articles, of which six were included. Significant decreases in the Ocular Surface Disease Index (OSDI) score, meibomian gland dysfunction (MGD) score, MGD grade, and meiboscore and increases in tear film stability, lipid layer thickness, and loss area of the meibomian gland have been reported. Concerning tear volume, tear meniscus height, and Schirmer test remained unchanged. In relation to tear osmolarity and corneal fluorescein staining, contradictory outcomes were found. CONCLUSIONS Intense pulse light combined with LLLT for the treatment of dry eye improves OSDI, tear film stability, and meibomian gland function; thus, this treatment may be recommended for DED patients due to MGD.
Collapse
Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Ophthalmology (A.B.S., B.G.M), Clínica Novovisión, Murcia, Spain; Department of Ophthalmology and Optometry (B.G.M.), University of Murcia, Murcia, Spain; and Department of Physics of Condensed Matter (J.M.S.G., M.C.S.G.), Optics Area, University of Seville, Seville, Spain
| | | | | | | |
Collapse
|
9
|
Borgia A, Raimondi R, Fossati G, De Rosa FP, Romano V, Borroni D, Vigo L, Scorcia V, Giannaccare G. Device-based therapies as a boost of conventional treatment in dry eye disease. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2147928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alfredo Borgia
- Eye Unit, Humanitas-Gradenigo Hospital, Turin, Italy
- Department of Corneal Diseases, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Raffaele Raimondi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Giovanni Fossati
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | | | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Luca Vigo
- Carones Ophthalmology Center, Milan, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Catanzaro, Italy
| |
Collapse
|
10
|
Carroll JD. Photobiomodulation Literature Watch December 2021. Photobiomodul Photomed Laser Surg 2022. [DOI: 10.1089/photob.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|